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De Quervain’s Syndrome

Also known as first dorsal compartment tenosynovitis…but it’s a lot easier to remember the name of the French dude who first described this pesky little condition; Fritz de Quervain.

De Quervain’s syndrome describes a condition in which two tendons on the thumb side of the wrist get damaged and inflamed. No one’s really sure exactly why this happens. Maybe it’s because they rub against the prominent bump on the end of the wrist, or maybe the sheath or tube in which they travel gets too tight for the inflamed or damaged tendons. Suffice it to say that it’s another one of those adult repetitive strain conditions I’ve written about so many times. I’ve never seen it in anyone under the age of twenty-five…maybe thirty, but I got it when I was thirty-one. It’s seen more often in women, particularly women who have just had a baby. That’s when I got it. Lifting babies in and out of cribs and chairs is at least partially responsible, but I’m pretty sure my husband lifted my daughter in and out of cribs and chairs just as much as I did, and he didn’t get it. But two thirds of the people I’ve seen with de Quervain’s syndrome are older and not recently pregnant. I can probably count on less than half of one hand, the number of men on whom I have operated for this disease. So what I’m telling you is that this is just a frustrating condition to get because you haven’t done anything to ask for it…like you’re not doing squats or riding motorcycles or skydiving, or playing football…activities in which you are just asking for it…whatever “it” might be. It’s usually something for which you have to see me. But you usually end up seeing me for de Quervain’s syndrome anyway.

Do you have it? Turn your hand so that your thumb faces up. You’re looking down on the side of your wrist and the back of your thumb is facing you. Now raise your thumb like you’re hitch hiking. Does that hurt? Can you see the tendons which form an inverted V on the side of your thumb and wrist? The tendon that is closer to your palm is the problem. Notice how it is easily seen coursing up the side of your thumb, but as it approaches your wrist, it disappears. It’s actually two tendons; one extends the end of your thumb and the other pulls your thumb away from your palm. Those are the two motions needed to hitch hike…and a lot of other things too. If the area where it disappears is tender or swollen, then you’ve got de Quervain’s syndrome.

Let’s try another test. Grasp your thumb within your fist, like if you’re trying to hide your thumb inside your fist. Now squeeze your fist tight. Oh yeah. Did that hurt? If not, then just take that fist, with the hidden thumb in it and point it downward, away from your face, like the motion you would make if you had a fishing pole in your hand and you were testing to see if you’d caught something. Ouch. If that hurts, then you’ve got de Quervain’s syndrome. 

Hope you’ve caught this in its early stages because in my experience; both personal and professional, if you’ve had it for a long time, it’s not likely to get well with standard conservative treatments. But it’s always worth a try.

Start by using my general principle of treating any repetitive strain disorder; don’t do the things that hurt. People often think they can work through these problems, but that almost never works. Maybe it works after a couple of years but most of us don’t want to wait around for that. So just stop doing the things that hurt.

Of course that’s always easier said than done. And with this little sketchy condition, you can go days without hurting it and then just when you think you’re on the way to wellness, you grab a doorknob and it drops you to your knees. Use your other hand for a while if need be.

Sometimes it helps to use a brace, more for a reminder than an actual immobilizer. If you stay in a brace too much, it will kill you to take it off because your tendons will get used to staying in one position and they actually get a little stiff. As soon as you stop wearing the brace there is almost always immediate pain. So use the brace intermittently. Maybe you can predict times in which you will be more likely to strain these tendons. That’s when you use the brace.

Try OTC NSAIDS. Try ice. Try pain relieving salves like capsaicin or Ben-Gay. Just rub it. Try heat. Try acupuncture. Drink a beer.

Go see your primary care doc. Get prescription NSAIDS or a short course of prednisone (a Medrol Dosepak). That might work. Have some PT. Maybe that will help.

Go see your favorite orthopod and maybe get a shot. Probably got a less than a 50% chance of curing this…and it hurts a little.

So after a year of doing all of this, including the painful and useless shot, I had surgery and was well the next day. If I ever have it on the other hand, I’ll try the steroids and I’ll try to rest it for a while…and then I’ll have the surgery.

24 comments
  1. Debra Morgan

    Dr. Bergin — what is the recovery process after surgery?

    I got “tablet thumb” late last year as I sat with Mom at the hospital while she recovered from a stroke. I changed my tablet-using posture, but simple day-to-day tasks have become painful. I’m taking NSAIDS and using BioFreeze, trying to be smart about how I use my hand, and wearing a splint with thumb guard when I feel I need extra support.

    I’m the caregiver for three disabled family members, so I try not to spend too much time away from home. I may come see you to discuss options — I was in your office about a year ago for torn tendons in my foot (yard work accident).

    Thanks!

    1. Barbara

      It sounds like you’re doing all the right things. This may get better if you keep it up. Sometimes cortisone injections work. If you end up needing surgery, the recovery is very speedy. You can move your thumb/wrist immediately after surgery. You’ll have to take it easy for a few weeks while the incision heals, but you can get back to helping your family members the next day if you need to. When I had my surgery, I left the OR, went home, picked up my nine-month-old daughter and flew to Austin! Well, I didn’t actually do the flying. I think American Airlines did.

      1. Debra Morgan

        Thanks for the speedy reply, and encouragement! If things don’t improve in the next week or so, I may try an injection. Might call the family doc for a Medrol pack first.

    1. Barbara

      Ugh! Can’t help you with “thumb pain.” Could be a hundred different things. The most common thumb problems are arthritis at the base of the thumb (that is a condition of aging and some of us get it because we’re genetically predisposed to getting it). I’ve actually seen it in 40 year-olds though. Then there’s deQuervain’s syndrome as described in the article. A lot of people sprain the thumb at the middle joint. It’s also known as Gamekeeper’s Thumb. But I can’t tell you what you’re suffering from. Better go show it to a doc!

  2. A Rao

    So I got De Quervains from a fall that fractured my thumb and scaphoid. I waited 10 months using NSAIDS and a store bought splint and exercises before we had the proper insurance to allow me to see the ortho. I have had 2 shots – 1 today – I wanted to know more about the chances of the 2nd shot helping and if I should seriously consider surgery since my doctor thinks its the best option. Also is there a genetic predisposition (I’m from Bombay but grew up in the US)? Additionally, I take levofloxacin abx for bronchitis infections about 2-3 times a year so could that increase my risk of not recovering?

    1. Barbara

      A,
      I can tell you from personal, as well as professional experience, that the surgery works. I think I mentioned in my blog, that I had injections on mine and they hurt…a lot, and they never fixed the problem. I had surgery and that day, despite some incisional pain, I could tell the condition was fixed. I’ve never had any problems with it since that time. I have always maintained that if I ever got it in my other wrist, I would brace it, take oral anti-inflammatories, and then have the surgery. I would never take a shot again. In my experience they usually don’t cure the problem. Sometimes shots “work,” and to me that means they might temporarily get rid of the pain, but patients most often come back, weeks or months later, asking for another shot (because it “worked”) or for the surgery. If a shot “cures” the condition, then it truly “worked.” But if the pain came back then it really didn’t cure the problem, did it? So it’s up to you and your doc. Try a second shot or have surgery. If it were my wrist and I knew for a fact I had deQuervain’s, I’d go for the surgery, unless there’s some other reason not to (health, fear of surgery, etc.).

        1. Barbara

          That’s a great question. When I had that deQuervain’s release, it was on the last day of my residency. I was the last case of the day. My husband had already left for Austin with a U Haul. I had it done under local because I was catching a plane that day to Austin, TX with my infant daughter in tow. So no medications whatsoever. The surgery was a tad painful under a local anesthetic and I only do it under local for my patients who demand it or who are poor candidates for general anesthesia.
          A year ago I had bilateral carpal tunnel releases under general anesthesia. As long as I’m healthy…I’m going to sleep.

  3. Anu

    Hi,
    I am 33 year old female, gave birth to a baby 9 months back and I am a stay at home mom taking care of the baby 24×7 and doing the household work. I am still breastfeeding. I havery pain under my thumb and the doctor diagnosed it as de quervains tenosynovitis. He recommended me a wrist splint and I am using it. He also prescribed me methylprednisolone tablets . I am little worried about taking them because I am still breastfeeding and it is a steroid. Please give me your suggestions. I am not in a position to give complete rest to that wrist as my husband goes to work and I have to take care of my very wiggly baby . Now there is some pain but still manageable. Will my condition get worsened if I don’t take this medication or did not give complete rest to that wrist. Please give me your suggestions

    1. Barbara

      Anu,
      Keep one important thing in mind: deQuervain’s syndrome is a benign, painful condition. That means it’s not going to ruin your tendon, your wrist, or any joint. It’s just painful. So in my practice, I prefer not to use medications on women who are pregnant or breast feeding unless it’s absolutely essential (like antibiotics for an infection). I didn’t breast feed so I took medications and injections…none of which worked. So I had the surgery and my condition was “cured” on the day I had that operation. It’s an easy operation to do and to have. It’s extremely rare to have complications. If the wrist is killing you and you can’t bear it anymore…talk to your doc about surgery. If I got deQuervain’s on my other hand, between you and me, I would take a medrol dosepak (short course of steroids), wear a brace for a little while, and if that didn’t work, I’d probably go straight for that operation.

      Talk to your pediatrician about taking the short course of steroids. They’ll probably say it’s fine. I had to take a long course of steroids WHILE I WAS PREGNANT! I vomited so much, and at one point aspirated and got aspiration pneumonia! Really weird. But I had to take steroids and antibiotics during the first trimester. My son was born healthy, without complications and no effects from the medications.

      Another option is to store breast milk and then use that while you’re on the medrol dosepak. If rest, bracing and a medrol dosepak don’t work, maybe you go for the operation. That’s what I did. And I always think about what I would do for myself or my friends or family, when I consider my recommendations for my patients.

      Of course, you have to be absolutely sure you have deQuervain’s syndrome.

  4. Kelly

    I have had it going on three years now in my right wrist. I have worn the brace for six weeks, done one injection and they hurt by the way. A year later I went back for another injection, that one didn’t even last a year. I am scheduled for surgery May 1, 2017. I will miss 4-6 weeks of work because of what I do for a living. I do a lot of heavy lifting and pushing and pulling heavy objects.

    I am 37 years old and have no children. I was told repeat movements at work and really no time to rest the wrist is what caused it. I also have developed it in the left wrist as well, but my last injection was three years ago for that one. Haven’t had any problems until the pain got really bad in my right wrist. When I baby the right wrist too much the pain comes back in the left one.

    1. Barbara

      Kelly,
      As I said in my blog, I had this in my wrist and the surgery cured it after all else failed. I don’t know of any proven relationship between repetitive labor and deQuervain’s. That being said, I have an occasional patient with this who has a workers’ comp claim. But most cases occur in the general population. Bottom line…we use our hands and therefore we get deQuervain’s syndrome. The only group of people it most commonly affects is women who have recently had a baby…even a few grandmothers. We believe that the shape of women’s wrists probably predisposes them to it. I have treated only one guy with it in my whole career…and many women.

  5. Jim

    Thank you SO much for your article. I got De Quervain’s from a 4 hour guitar session- I was excited about successfully learning a new tune, and at 53 I’ve still not accepted that I’m no longer a physically resilient 17. I also have a very prominent bone bump on the affected wrist, which I’ve suspected as impeding healing, especially when the PT folks run over it with the ultrasound wand, but everyone has shrugged it off with a “maybe”.

    It’s been an interminable 8 weeks so far, and as you said, just when I think it’s getting better, Lucy pulls the football away. Your perspective gave me a dose of reality.

    jim

    1. Barbara

      Based on my experience with DeQuervain’s syndrome, I would give myself a short course of conservative treatment, and if that didn’t work, I would have surgery. It’s a simple operation, very unlikely to have complications, and it works…provided you have only DeQuervain’s syndrome. It’s rare for men to have DeQuervain’s. We think this might be due to the shape of the bone under that first dorsal compartment in women. But the fact that you have a prominence there, might make you more susceptible.

  6. Joy

    My ortho diagnosed DeQuervain’s in my right thumb/wrist. I also have basal thumb arthritis, but it has never given me much trouble. My thumb/wrist hurt right on the prominent bump, especially when I stretch my thumb outward. It hurts the most at night when I’ve been sleeping. Sometimes it feels like a burning pain. The trouble started the day after my cat tripped me and I fell and got a non-displaced fracture of my right radial head. The elbow healed, but my thumb/wrist have been hurting for eight months. I never had this pain before the fall and elbow break, so I wonder if that was the cause. It’s really painful to write or use scissors or open doors or jars. I wear a brace quite often and try to rest it. I’ve heard it takes a long time to heal. Should I just wait it out?

    1. Barbara

      I think you’ve waited it out long enough. If your doc feels you truly have deQuervain’s, you could try an injection. They don’t usually work, but even temporary relief might be diagnostic, and confirm that you have deQuervain’s. Sometimes, when the history and physical are not classic for deQuervain’s, I will order an MRI. Your history is not classic for the syndrome. But in terms of waiting it out, I think you’ve done that plenty long. If you truly have deQuervain’s, the surgery will cure your problem.

  7. Elizabeth Stuart

    Wow – thank you so much for this site and thread! I’m female in my late 50’s, right-hander with DeQ diagnosed in left wrist/thumb. More than 6 months ago I woke up with the pain (I remember that pulling my pants up and down to go to the bathroom was excruciating), thought it would go away, saw my dr (nurse practitioner) after 2 months. Finklestein’s test showed DeQ. Even though it seemed to come on suddenly, I suspect it may have been caused by left hand smart phone usage – and possibly exacerbated by playing lots of hand percussion and piano) She prescribed naproxen and ice. Did that for a while – didn’t seem to help much and made my stomach feel awful. Tried acupuncture – no help at all. Chiropractic with Active Release Technique. No help. Went online to watch many vids of PTs doing movements and self massage – that seemed to start making it feel better. Finally asked my doc to prescribe PT. Finally it’s getting a little better, slowly (have increased range of motion almost to normal, some days pulling my pants up/down is not painful, but some days it is a little painful still) but, e.g., I can’t can’t do pushups/downward dog in he normal way, with wrist bent back/bearing weight, (stopped playing piano with my left hand for 6 months to let it rest which has made me sad) and now when I try playing piano with my left hand it is still painful if I do normal octave stretches (so i still avoid that) and if I accidentally bump my left hand or thumb against something, or make certain sudden voluntary or involuntary moves with my hand – yeowch!! I haven’t tried taping – my PT just suggested that. My brother (nurse practitioner in another state who also has DeQ) suggested I see an Ortho and get an MRI. There is a good hand ortho in my area (Berkeley, CA) who’s on my insurance. Given that it finally does seem to be getting slowly better – should I stay on track with PT and try taping, or should I see an ortho. Maybe surgery would take care of it once and for all. Thanks for your help!

    1. Barbara

      Yes, surgery will take care of it once and for all. But please stop the pushups and downward dog. Humans evolved into upright critters, and we’re not built for long term crawling around on all fours. Lift weights, but don’t bear weight on your wrists and shoulders. It’s bad juju, especially if you want to do things that you ARE built to do, like play the piano and drums! These are things you will be able to do until you are very old, unless you mess up your hands and shoulders pretending to be a dog. Just my two cents.
      Hey, if you like my blog, please forward to friends and family, and suggest they subscribe! This is the only way I get to prevent 100,000 injuries before I retire!

  8. Kerry

    I so hope you are on line. I am an RN…59….nurse manager is Australia. I have lymphoedema L arm post Breast Ca and nodal clearance. I am now 5 years clear ….triple negative…no meds. Yesterday my left hand was sore….not anymore swollen than normal. IBy evening I had pain in my wrist….worse on movement of thumb and forefinger. Terrible night..pain worsened…I tried heat..cold…varying form of compression sleeves.. elevation…..strapping… nsaids….Panadol…magnesium…. yes typical nurse. I am located 100kms from a dr…not sure I could drive…. can’t grasp anything…… is this sounding like de Quervain’s do you think. I am not a candidate for surgery whatever it is…lymphoedema…..I did nothing …no injury ….. what do you think. I need to see Dr but need to be able to get there and get back to work tomorrow….in a large town 2 hous away. Would be thankful for any advice please.

    1. Barbara

      Whoa! While I do love having all my readers from Australia, I prefer not to get urgent requests for direct medical care. I did however, send you an email. The reason this post is scary to me, is that since I can’t examine you, and so I don’t know if you’re having a vascular problem or an infection. But if it’s just deQuervain’s, and if a patient had no contraindications to taking NSAIDs, I would start that, and somehow immobilize my hand, perhaps with an ace bandage, or even one of those compression stockings they use for lymphedema control. Even though you are not an ideal candidate for surgery, if this became critically painful, this is a surgery that can be done under local anesthetic. I suffered from deQuervain’s for a year before finally having the surgery, and believe me, I would have figured out a way to have it, after everything else failed, including injections. But I could not rest my hand. Perhaps you can, and that’s what you must do. If you have no contraindications to taking over the counter NSAIDS like naprosyn or ibuprofen (please look those up if you don’t know whether or not you can take them), then try them. Ultimately, you might need to try an injection, but you’d have to go to town for that.

      Obviously, since I can’t examine you, I can’t tell you that you have deQuervain’s and not something worse, like a fracture, an infection or something related to your breast cancer or lymphedema. So please don’t use this posting as a replacement for good, hands on medical care. Go see your doctor if there is any question in your mind regarding what it is you’re suffering from.

  9. Marie

    Thanks for the article (and your honesty!)
    I just turned 26, mother of two, student, and I work in a Vascular Surgery department. I have DQ, with flares on and off for 5-6yrs. Now it’s wild bad, to the point where I can’t sleep. I’m on my second round of steroids, this time straight prednisone tapered for 2wks. However, I can’t get into Ortho-Hand for two months! Do you think I should discuss with my PCP about extending out my oral steroid dose? Whenever I go off of oral steroids, my pain is as follows on a 1-10 post-treatment:
    Day 1: 0
    Day 2: 3-5 (usually amplified to a 7-9 by the evening/early AM)
    Day 3: Solid 9

    At this point I’m going to refuse injections because I don’t foresee them lasting long. I need relief, and to make sure this is managed before August when I begin my final stretches in my degree.

    1. Barbara

      Where in the world do you live that you can’t get in to see an ortho for two months? A general orthopedist can do this surgery with one arm tied behind her back. Get on a plane and come to Austin. I’ll see you Tuesday and have you in surgery on Thursday…haha! Are you in some country with socialized medicine…or the U.S. Military? That would explain it. In my opinion you should not extend the steroid treatment. It probably won’t work. The hand guy…when you see him, will probably recommend an injection, which likely won’t work, and hurts like hell. But maybe you’ll have to try it before they’ll let you have the surgery. That’s fine. It might work. Do you have a thumb spica brace? See if you can find one. That will at least rest your hand and wrist. Sorry. I remember how miserable I was with that condition. I was back to operating a week after my surgery!

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